Reduced mobility is associated with adverse outcomes after in-hospital cardiac arrest

SUMMARY OBJECTIVE: In-hospital cardiac arrest is a critical medical emergency. Knowledge of prognostic factors could assist in cardiopulmonary resuscitation decision-making. Frailty and functional status are emerging risk factors and may play a role in prognostication. The objective was to evaluate the association between reduced mobility and in-hospital cardiac arrest outcomes. METHODS: This retrospective cohort study included patients over 18 years of age with in-hospital cardiac arrest in Botucatu, Brazil, from April 2018 to December 2021. Exclusion criteria were patients with a do-not-resuscitate order or patients with recurrent in-hospital cardiac arrest. Reduced mobility was defined as the need for a bed bath 48 h before in-hospital cardiac arrest. The outcomes of no return of spontaneous circulation and in-hospital mortality were evaluated. RESULTS: A total of 387 patients were included in the analysis. The mean age was 65.4±14.8 years; 53.7% were males and 75.4% had reduced mobility. Among the evaluated outcomes, the no return of spontaneous circulation rate was 57.1%, and in-hospital mortality was 94.3%. In multivariate analysis, reduced mobility was associated with no return of spontaneous circulation when adjusted by age, gender, initial shockable rhythm, duration of cardiopulmonary resuscitation, and epinephrine administration. However, in multiple logistic regression, there was no association between reduced mobility and in-hospital mortality. CONCLUSION: In patients with in-hospital cardiac arrest, reduced mobility is associated with no return of spontaneous circulation. However, there is no relation to in-hospital mortality.

Rasgos de profesionalidad médica en el ámbito de la atención primaria: respeto por la autonomía / Traits of medical professionalism in the field of primary care: respect for autonomy

Fundamento: el respeto por la autonomía del paciente y una conducta respetuosa en general son rasgos centrales de la profesionalidad médica. Objetivo: indagar la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general en las expresiones verbales de profesionales del ámbito de atención primaria de la salud durante su interacción con pacientes y estudiantes del último año de la carrera de Medicina. Métodos: se efectuó una investigación cualitativa de carácter exploratorio en contextos de prácticas finales obligatorias en dos Centros de Atención Primaria de la Salud de la ciudad de Tandil, República de Argentina, durante el año 2019. Como métodos teóricos se emplearon: análisis-síntesis, inductivo-deductivo y método de revisión crítica de la literatura y empírico: se realizó el registro grabado de 28 encuentros entre expertos, estudiantes y pacientes. Las sesiones se analizaron mediante triangulación de investigadores. Resultados: las expresiones verbales de los expertos permitieron identificar enunciados relacionados con rasgos de respeto en general y respeto por la autonomía de los pacientes. Estos se evidenciaron en enunciados para construir un ambiente de confianza y confidencialidad, el esfuerzo por brindar explicaciones de forma clara y sencilla, la atención a las dudas de los pacientes y la formulación de explicaciones sobre cómo proceder, en un lenguaje accesible. Conclusiones: se identificó la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general, tanto en las interacciones con pacientes como con los estudiantes.

Background: respect for the autonomy of the patient and a respectful behavior in general are key features of medical professionalism. Objective: to investigate the presence of professional traits of respect for the autonomy of patients and of respect in general in the verbal expressions of professionals in the field of primary health care during their interaction with patients and students in the last year of the Medicine degree. Methods: a qualitative research of an exploratory nature was carried out in the context of mandatory final practices in two Primary Health Care Centers in the city of Tandil, Republic of Argentina, during the year 2019. The following theoretical methods were used: analysis-synthesis, inductive-deductive and method of critical review of the literature and empirical ones: the recorded record of 28 meetings between experts, students and patients was made. The sessions were analyzed by opposing sources of researchers. Results: the verbal expressions of the experts made it possible to identify statements related to traits of respect in general and respect for the autonomy of the patients. These were evidenced in statements to build an environment of trust and confidentiality, the effort to provide explanations in a clear and simple way, the attention to the patients' doubts and the formulation of explanations on how to proceed, in an accessible language. Conclusions: the presence of professional traits of respect for the autonomy of patients and respect in general was identified, both in interactions with patients and with students.

Bleeding hepatocellular adenoma: historical series and outcomes / Adenoma hepatocelular sangrante: série histórica e desfechos

ABSTRACT Introduction: hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. Methods: between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. Results: all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. Conclusion: it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.

RESUMO Introdução: o Adenoma Hepatocelular - AHC - é uma neoplasia benigna rara do fígado associada a mulheres com idade reprodutiva. Sua principal complicação é o sangramento,mas as séries de casos direcionadas a esta intercorrência são limitadas. Métodos: entre os anos de 2010 e 2022 foram registrados 12 casos de AHC sangrante em um hospital universitário de alta complexidade no sul do Brasil, cujos prontuários foram retrospectivamente avaliados. Resultados: todos os pacientes eram do sexo feminino, com média de idade de 32 anos e de IMC de 33kg/m2. O uso de anticoncepcionais foi identificado em metade da amostra e também metade das pacientes apresentava lesão única. O diâmetro médio da maior lesão foi de 9,60cm e a maior lesão foi responsável pelo sangramento em todos os casos. Hemoperitôneo foi documentado em 33% das pacientes e a idade destas foi significativamente maior do que as pacientes que não apresentaram hemoperitôneo - 38 vs 30 anos, respectivamente. A ressecção cirúrgica da lesão sangrante foi realizada em 50% das pacientes e a mediana de dias entre o sangramento e a ressecção foi de 27 dias. Em apenas um caso foi lançado mão da embolização da lesão. Não se demonstrou correlação entre a taxa de redução das lesões e o passar dos meses, nos casos em que foi adotado tratamento conservador. Conclusão: conclui-se que aos AHC sangrantes da presente série apresentam concordância epidemiológica com a literatura e pode sugerir que as pacientes com maior idade tendem a apresentar hemoperitôneo mais frequentemente, fato que deve ser investigado em maiores estudos.

Principales fitoquímicos con potencial terapéutico en el tratamiento de la retinopatía diabética con fitofármacos / Major Phytochemicals with Therapeutic Potential in the Treatment of Diabetic Retinopathy

La diabetes mellitus tipo 2 representa uno de los principales problemas de salud pública a nivel mundial hoy en día. Entre las principales complicaciones generadas por esta enfermedad se encuentra la retinopatía diabética, la cual puede conducir a pérdida de la visión de manera permanente, por lo que investigaciones sobre tratamientos para esta patología van en aumento. Es por esto que tratamientos en base a químicos obtenidos de plantas medicinales están siendo ampliamente investigados debido a que podrían proveer una alternativa más segura, de menor costo y menor toxicidad que la medicina estándar para el tratamiento de esta patología ocular de alta incidencia mundial. El objetivo de este estudio fue identificar los principales fitoquímicos con potencial para ser usados como tratamiento de la retinopatía diabética. Para lograr este cometido se llevó a cabo una revisión de la literatura publicada entre el enero 2017 y de junio 2021 utilizando las bases de datos WOS, PubMed y Scopus en inglés y español, con el fin de recopilar evidencia científica actualizada sobre el uso y efectos de fitoquímicos en la retinopatía diabética. Diversas familias de fitoquímicos útiles fueron identificadas, entre estas las más comunes fueron las de origen fenólico, aunque menos comunes también se encontraron carotenoides, terpenos y preparaciones constituidas por varias especies de plantas y fitoquímicos. Sus mecanismos de acción también fueron identificados, siendo los más comunes la supresión de la neovascularización mediada por VEGF, la protección y restauración de la barrera hematorretinal, la reducción en la actividad de las especies reactivas del oxígeno y el efecto antiinflamatorio. Dada la evidencia respecto a la utilidad de los fitoquímicos para el tratamiento de la retinopatía diabética, mayores investigaciones deben ser realizadas(AU)

Type 2 diabetes mellitus represents one of the main public health problems worldwide today. Among the main complications generated by this disease is diabetic retinopathy, which can lead to permanent vision loss. For this reason, research on treatments for this pathology is increasing. This is why treatments based on chemicals obtained from medicinal plants are widely investigated as they could provide a safer, less costly and less toxic alternative to standard medicine for the treatment of this eye disease of high incidence worldwide. The aim of this study was to identify the main phytochemicals with potential to be used as treatment for diabetic retinopathy. In order to achieve this purpose, a review of the literature published between January 2017 and June 2021 was conducted using the WOS, PUBMED and Scopus databases in English and Spanish, in order to compile updated scientific evidence on the use and impact of phytochemicals in diabetic retinopathy. Several families of useful phytochemicals were identified. Among these, the most common were those of phenolic origin, although less common were also found carotenoids, terpenes and blends consisting of various plant species and phytochemicals. Their mechanisms of action were also identified, the most common being suppression of vascular endothelial growth factor-mediated neovascularization, protection and restoration of the blood-retinal barrier, reduction in reactive oxygen species activity and anti-inflammatory effect. Given the evidence regarding the usefulness of phytochemicals for the treatment of diabetic retinopathy, further research should be conducted(AU)

Autologous Anti-CD19 CAR T-Cells immunotherapy in relapsed/refractory acute lymphoblastic leukemia patients. A systematic review and meta-analysis / Imunoterapia de CAR T-Cells Anti-CD19 no tratamento de leucemia linfoblástica aguda refratária/recidivante. Revisão sistemática e metanálise

Introduction: Acute Lymphoblastic Leukemia (ALL) is the most prevalent malignancy in children; however, when the neoplasm becomes refractory/relapses (R/R) the cure possibilities are practically null. Objectives: To analyze the Anti-CD19 Chimeric Antigen Receptors (CAR) T-Cells immunotherapy efficacy in the treatment of R/R ALL, providing evidence about the efficacy and safety of the therapy for the analyzed group. Methods: The study consisted of a systematic review and meta-analysis based on the analysis of indexed articles. The searches were carried out with the terms: "acute lymphoblastic leukemia", "CAR T", and "CD19-specific chimeric antigen receptor". Results: Only 18 of the 94 articles obtained initially met the inclusion criteria and were selected for review, totaling 637 patients. Thus, it was observed in the responses that approximately 81% of the patients achieved a Complete Response; 7% did not respond; the neoplasm relapsed in 17% of the cases; and 6.1% of the patients died. The main side effects found were Cytokine Release Syndrome (CRS), Severe Cytokine Release Syndrome, and Neurotoxicity, present in 36.3%, 29%, and 24% of patients, respectively. Conclusion: Anti-CD19 CAR T-Cells immunotherapy is an effective therapy, capable of producing high rates of complete remission in R/R ALL treatment. [au]

Introdução: A Leucemia Linfoblástica Aguda (LLA) é a neoplasia maligna mais prevalente em crianças; entretanto, quando se torna refratária/recidivante (R/R) as possibilidades de cura são praticamente nulas. Objetivos: Analisar a eficácia da imunoterapia de Receptores de Antígenos Quiméricos anti-CD19 no tratamento da LLA R/R, fornecendo evidências sobre a efetividade e segurança da terapia para o grupo analisado. Métodos: O estudo consistiu em uma revisão sistemática e metanálise baseada em artigos indexados. As pesquisas foram realizadas com os termos: "acute lymphoblastic leukemia", "CAR T", and "CD19-specific chimeric antigen receptor". Resultados: Dos 94 artigos obtidos, apenas 18 atenderam inicialmente aos critérios de inclusão e foram selecionados para revisão, totalizando 637 pacientes. Assim, observou-se nas respostas que aproximadamente 81% dos pacientes obtiveram resposta completa; 7% não responderam; a neoplasia recidivou em 17% dos casos; e 6,1% dos pacientes morreram. Os principais efeitos colaterais encontrados foram síndrome de liberação de citocinas, síndrome de liberação grave de citocinas e neurotoxicidade, presentes em 36,3%, 29% e 24% dos pacientes, respectivamente. Conclusão: A imunoterapia com células CAR T anti-CD19 é uma terapia eficaz, sendo capaz de produzir altas taxas de remissão completa no tratamento de LLA R / R. [au]

Giant Cell tumor of the Zygomatic Arch in a Pediatric Patient: Rare Case Report / Tumor de Células Gigantes do Arco Zigomático em um Paciente Pediátrico: Relato de Caso Raro / Tumor de Células Gigantes del Arco Cigomático en un Paciente Pediátrico: Informe de un Caso Raro

Introduction: A giant cell tumor (GCT) is a rare tumor, usually benign, which can be locally aggressive, with an almost unknown incidence in the skull. Case report: Case report of a pediatric patient diagnosed with Ewing's sarcoma (ES) and later GCT when sought medical care for an increased volume in the zygomatic arch and the right preauricular region. Imaging exams showed an expansive lesion in the zygomatic and squamous portion of the right temporal bone, with an extradural intracranial component in the middle fossa, with no evidence of infiltration. From the anatomopathological view, fusocelullar neoplasia was seen. The CD68 marker was positive and the S100 marker was negative. Tumor resection by microsurgery was performed. The patient remains in follow-up, with imaging exams at neurosurgery and orthopedics, the latest magnetic resonances of the skull showing a reduction in the size of the lesion. In addition, the patient did not submit to adjuvant therapy and is currently without complaints. Conclusion: This is an important case due to its rarity and clinical data that contributes for the understanding of the pathologies presented, allowing that, in the future, new studies are able to optimize the treatment, and the prognosis for these patients

Introdução: O tumor de células gigantes (TCG) é raro, geralmente benigno, e pode ser localmente agressivo, com incidência quase desconhecida no crânio. Relato do caso: Paciente pediátrico com diagnóstico de sarcoma de Ewing (SE) e posteriormente de TCG, quando procurou atendimento médico por conta do aumento de volume em arco zigomático e região préauricular à direita. Os exames de imagem evidenciaram lesão expansiva em porção zigomática e escamosa do osso temporal à direita, com componente intracraniano extradural em fossa média, sem evidências de infiltração. Do ponto de vista anatomopatológico, observou-se neoplasia fusocelular. O marcador CD68 foi positivo e o marcador S100, negativo. Realizouse microcirurgia para ressecção do tumor. O paciente permanece em acompanhamento com exames de imagem nos serviços de neurocirurgia e ortopedia, com as últimas ressonâncias magnéticas de crânio mostrando redução no tamanho da lesão. Além disso, não realiza terapia adjuvante e atualmente não apresenta queixas. Conclusão: Este é um caso importante em razão da sua raridade e dos dados clínicos que agregam informações sobre as patologias apresentadas, permitindo que, no futuro, novas pesquisas possam otimizar o tratamento da referida neoplasia e o prognóstico desses pacientes

Introducción: El tumor de células gigantes (TCG) es un tumor raro, generalmente benigno, que puede ser localmente agresivo, con una incidencia casi desconocida en el cráneo. Relato del caso: Paciente pediátrico diagnosticado con sarcoma de Ewing (SE) y posteriormente con TCG, cuando procuró atención médica por aumento de volumen en arco cigomático y región preauricular derecha. Los exámenes de imagen mostraron una lesión expansiva en la porción cigomática y escamosa del temporal derecho, con componente intracraneal extradural en la fosa media, sin evidencias de infiltración. Desde el punto de vista anatomopatológico, se observó neoplasia fusocelular. El marcador CD68 fue positivo y el marcador S100 negativo. Se realizó microcirugía para resecar el tumor. El paciente permanece en seguimiento con exámenes de imagen en los servicios de neurocirugía y ortopedia, con las últimas resonancias magnéticas de cráneo mostrando una reducción en el tamaño de la lesión. Además, no se somete a terapia adyuvante y actualmente no tiene quejas. Conclusión: Este es un caso importante por su rareza y datos clínicos que agregan informaciones sobre las patologías presentadas, permitiendo, en el futuro, nuevas investigaciones para optimizar el tratamiento de la neoplasia referida, y el pronóstico de estos pacientes

Metodologías activas, desarrollo del aprendizaje conceptual y trabajo colaborativo en estudiantes universitarios de Medicina / Active methodologies, development of conceptual learning and collaborative work in medical university students

RESUMEN Fundamento: el enfoque curricular por competencias favorece el aprendizaje activo de los discentes, lo que permite desarrollar competencias que pueden proyectarse más allá del aula. Objetivo: determinar el impacto de la aplicación de metodologías activas en el desarrollo de las competencias de trabajo colaborativo y aprendizaje conceptual en estudiantes de la carrera de Medicina. Métodos: se utilizó un diseño cuasiexperimental de corte longitudinal con un grupo control y tres grupos experimentales, realizado en 2019. La muestra fue 84 alumnos (cohortes 2018 y 2019) de la carrera de Medicina. Se aplicó metodologías activas a tres grupos experimentales y se utilizó la clase expositiva tradicional en el grupo control. El Autoinforme de Interacción Grupal (AIG) fue el instrumento utilizado para medir el trabajo colaborativo y el mapa conceptual para evidenciar el desarrollo del aprendizaje conceptual, con un de Alfa de Cronbach de 0,92 y 0,88, respectivamente. El análisis estadístico consideró la Prueba de Rangos de Friedman para más de dos muestras relacionadas. Resultados: la aplicación de las metodologías activas de intervención favorecieron el desarrollo del trabajo colaborativo y el nivel de aprendizaje conceptual en comparación al grupo control (metodología expositiva), el cual no logró resultados estadísticamente significativos (p> ,05). Conclusiones: el aprendizaje activo en los discentes fue favorecido por metodologías activas de intervención, que permitieron un desarrollo del aprendizaje conceptual con un mayor grado de reflexión en la medida en que se desarrolló el trabajo colaborativo, lo que a su vez se fortaleció en el tiempo.

ABSTRACT Background: the competency-based curricular approach favors the active learning of students, which allows them to develop competencies that can be projected beyond the classroom. Objective: to determine the impact of the application of active methodologies in the development of collaborative work skills and conceptual learning in Medicine students. Methods: a longitudinal quasi-experimental design was used with a control group and three experimental groups, it was carried out in 2019. The sample comprised 84 students (cohorts 2018 and 2019) of the Medicine degree. Active methodologies were applied to three experimental groups and the traditional expository class was used in the control group. The Group Interaction Self-Report (AIG) was the instrument used to measure collaborative work and the conceptual map to evidence the development of conceptual learning, with a Cronbach's Alpha of 0.92 and 0.88, respectively. Statistical analysis considered the Friedman Rank Test for more than two related samples. Results: the application of active intervention methodologies favored the development of collaborative work and the level of conceptual learning compared to the control group (expository methodology), which did not achieve statistically significant results (p> .05). Conclusions: active learning in students was favored by active intervention methodologies, which allowed a development of conceptual learning with a greater degree of reflection to the extent that collaborative work was developed, which in turn was strengthened over time.

COVID-19 cutaneous manifestations in children and adolescents: a systematic review / Manifestações cutâneas da COVID-19 em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: The aim of this study was to evaluate the coronavirus disease 2019 (COVID-19) cutaneous manifestations described in pediatric patients and discuss their relevance for early diagnosis. Data source: The study consisted of a systematic review of original articles indexed in PubMed and Embase databases, as well as gray literature articles found through Google Scholar. A search strategy, based on PICO (Patient, Intervention, Comparison, Outcome) Tool, with the terms "child," "infant," "childhood," "adolescents," "teenagers," "COVID-19," "SARS-CoV-2," and "skin manifestations," was performed to optimize the findings. The study did not restrict any article regarding language. Data synthesis: Out of the 310 articles that initially met the inclusion criteria, 35 were selected for review, totalizing 369 patients. The most common COVID-19 cutaneous manifestations in children and adolescents were Chilblain-like lesions, presented in 67.5% of the cases, followed by erythema multiforme-like (31.7%) and varicella-like lesions (0.8%). The Chilblain-like lesions appeared 7.6 days (95%CI 7.4-7.8) after the viral infection and lasted for 17.5 days (95%CI 16.5-18.5), erythema multiforme-like lesions appeared in 9.5 days (95%CI 9-10) and lasted for 10.3 days (95%CI 9.1-11.5), and varicella-like lesions appeared in 12.3 days (95%CI 4-20.6) and lasted for 7 days. Conclusions: Knowledge of the different skin manifestations in children and adolescents with COVID-19 is essential for an early diagnosis and, consequently, the possibility of promptly care adoption as well as to interrupt the new coronavirus transmission chains in the current pandemic context.

RESUMO Objetivo: Avaliar as manifestações cutâneas da Doença de Coronavírus 2019 (COVID-19) descritas em pacientes pediátricos e discutir sua relevância para o diagnóstico precoce. Fontes de dados: O estudo consistiu em uma revisão sistemática de artigos originais indexados nas bases de dados PubMed e Embase, assim como na literatura cinzenta localizados via Google Scholar. Uma estratégia de busca, baseada na PICO (Patient, Intervention, Comparison, Outcome) Tool, com os termos "child", "infant", "childhood", "adolescents", "teenagers", "COVID-19", "SARS-CoV-2" e "skin manifestations" foi conduzida para otimizar os achados. Não houve restrições de idiomas. Síntese de dados: 35 dos 310 artigos que inicialmente cumpriram os critérios de inclusão foram selecionados para revisão, totalizando 369 pacientes. As manifestações cutâneas mais comuns de COVID-19 em crianças e adolescentes foram as lesões Chilblain-Like presentes em 67,5% dos casos, seguidas pelas lesões Eritema Multiforme-Like (31,7%) e Varicella-Like (0,8%). As lesões Chilblain-Like surgiram 7,6 dias (IC95% 7,4-7,8) após a infecção viral e tiveram duração de 17,5 dias (IC95% 16,5-18,5); as lesões Eritema Multiforme-Like surgiram em 9,5 dias (IC95% 9-10) e duraram 10,3 dias (IC95% 9,1-11,5) e as lesões Varicella-Like apareceram em 12,3 dias (IC95% 4-20,6) e duraram 7 dias. Conclusões: O conhecimento das diferentes manifestações cutâneas em crianças e adolescentes com COVID-19 é essencial para o diagnóstico precoce da doença, assim como possibilitar adoção de prontos cuidados e interromper cadeias de transmissão do novo coronavírus.

Metodologías de aprendizaje basado en problemas, proyectos y estudio de casos en el pensamiento crítico de estudiantes universitarios / Teaching-learning methodologies based on problems, projects and case-study for the development of critical thinking in university students

RESUMEN Introducción: el curriculum por competencias permite a los estudiantes aprender en contextos dinámicos para desarrollar competencias más allá del aula. Se utilizaron metodologías activas como el Aprendizaje Basado en Problemas, Aprendizaje Basado en Proyectos y Estudio de Casos, para el desarrollo del pensamiento crítico en los futuros profesionales de la salud. Objetivo: determinar el impacto de la aplicación de metodologías activas en el desarrollo de competencias como el pensamiento crítico en estudiantes de la carrera de Medicina. Métodos: diseño cuasi-experimental de corte longitudinal con un grupo control y tres grupos experimentales, realizado en 2019. La muestra fue 84 alumnos (cohortes 2018 y 2019) de la carrera de Medicina. Se aplicaron metodologías activas a tres grupos experimentales. El Test de Halpern permitió medir el pensamiento crítico, con Alfa de Cronbach: 0,724. El análisis estadístico consideró la Prueba de los Rangos con signo de Wilcoxon y la Prueba de Rangos de Friedman para dos o más muestras relacionadas, respectivamente. Se utilizó SPSS versión 21 para el análisis de los datos cuantitativos. Resultados: la aplicación de las metodologías activas de intervención favoreció el desarrollo de las habilidades del pensamiento crítico relacionadas con el razonamiento verbal, análisis de argumento y la probabilidad e incertidumbre, en comparación al grupo control (metodología expositiva) donde no fue estadísticamente significativo (p> 0,05). Conclusiones: el aprendizaje activo en los estudiantes fue favorecido por metodologías activas de intervención, las que además de contribuir al desarrollo del pensamiento crítico, permitieron fortalecerlo en el tiempo.

ABSTRACT Introduction: competency-based curriculum allows learners to learn in dynamic contexts to develop competencies beyond the classroom. Active methodologies such as Problem-based Learning, Project-based Learning and Case Studies were used to develop critical thinking in future health care professionals. Objective: to determine the impact of the application of active methodologies in the development of competencies such as critical thinking in medical students. Methods: longitudinal quasi-experimental design with one control group and three experimental groups, conducted in 2019. The sample comprised 84 students (cohorts 2018 and 2019) of the Medicine major. Active methodologies were applied to three experimental groups. The Halpern's test allowed measuring critical thinking, with Cronbach's Alpha: 0.724. The statistical analysis considered the Wilcoxon signed ranks test and Friedman's rank test for two or more related samples, respectively. SPSS version 21 was used for the analysis of quantitative data. Results: the application of active intervention methodologies favored the development of critical thinking skills related to verbal reasoning, argument analysis and probability and uncertainty in comparison to the control group (expository methodology) where it was not statistically significant (p> 0,05). Conclusions: active learning in the students was favored by active intervention methodologies, which, in addition to contributing to the development of critical thinking, allowed strengthening it over time.

Factors associated with the successful operation and participation of researchers in scientific networks of medical and health sciences in Colombia / Factores asociados al funcionamiento y participación exitosos de investigadores en redes científicas de ciencias médicas y de la salud en Colombia

Abstract Introduction: Scientific research in medical and health sciences is becoming increasingly complex. In this sense, research and innovation networks can be a key element for researchers to obtain up-to-date and useful knowledge. Objective: To analyze the participation in research networks of Colombian researchers working in medical and health sciences, as well as their characteristics and the factors associated with more involvement in said networks and better research and innovation achievements. Materials and methods: Descriptive and observational study conducted in two phases: the first, in 2016, consisted of sending a virtual survey on participation in and operation of these networks to the representatives of the 714 research groups in medical and health sciences officially recognized in Colombia, and the second, in 2017, consisted of sending a second survey to the 232 representatives who completed the first one. Relative frequencies were used for data analysis and description. Differences between participating in the networks and the characteristics of the researchers were determined using the chi-square test. A multivariate analysis (logistic regression model) was performed to determine the association between aspects of the network operation and the results obtained. Results: Of the 714 groups, only 232 representatives completed the first survey, and of these, only 82 (35.34%) participated in research networks. Significant differences were observed between participating in research networks and developing innovation products (p<0.01) and appearing in publication rankings (p=0.02). Regarding the network operation, there were three key elements: strategy, consensus, and funding; the first two correlate with obtaining results. Conclusions: Knowledge and innovation networks are important for generating more knowledge and research in the country. Therefore, the competent authorities should promote the creation of new research networks and encourage researchers from lagging regions in the country to participate in them.

Resumen Introducción. La investigación científica en ciencias médicas y de la salud es cada vez más compleja. En este sentido, las redes de investigación e innovación pueden ser un elemento clave para adquirir conocimiento actualizado y de utilidad para los investigadores. Objetivo. Analizar la actividad de investigadores colombianos del área de ciencias médicas y de la salud en redes de investigación, así como sus características y los factores asociados con una mayor participación y con mejores resultados en términos de investigación e innovación. Materiales y métodos. Estudio observacional descriptivo realizado en dos fases: la primera consistió en el envío de una encuesta virtual en 2016 sobre participación y funcionamiento de estas redes a los representantes de los 714 grupos de investigación en ciencias médicas y de la salud reconocidos oficialmente en Colombia, y la segunda, en 2017, en el envío de una segunda encuesta a los 232 representantes que respondieron la primera. Para el análisis y descripción de los datos se emplearon frecuencias relativas. Las diferencias entre la participación en redes y las características de los investigadores se determinaron mediante la prueba de chi-cuadrado. Se realizó un análisis multivariante (modelo de regresión logística) para determinar la asociación entre aspectos del funcionamiento de la red con los resultados obtenidos. Resultados. De los 714 grupos, solo contestaron representantes de 232, y, de estos, solo 82 (35.34%) participaban en redes de investigación. Se observaron diferencias significativas entre participar en redes y el desarrollo de productos de innovación (p<0.01) y aparecer en rankings de publicaciones (p=0.02). Respecto al funcionamiento de la red, hay tres elementos clave: estrategia, consenso y financiación; los dos primeros se correlacionan con la obtención de resultados. Conclusiones. Las redes de conocimiento e innovación son importantes para generar más conocimiento e investigación en el país; por tanto, las autoridades competentes debieran fomentar la creación de nuevas redes de investigación e incentivar a los investigadores de las regiones más rezagadas del país a participar en ellas.

The delay of breast cancer diagnosis during the COVID-19 pandemic in São Paulo, Brazil / O atraso no diagnóstico do câncer de mama durante a pandemia da COVID-19 em São Paulo, Brasil

ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on breast cancer diagnosis in a breast imaging center. Methods This was a retrospective cohort study that included women submitted to breast exams and procedures in a private hospital in São Paulo, SP, Brazil, as from the period of most strict social isolation measures, in 2020 (separated in first period of social isolation, March 24 to June 21, 2020, and second period, June 22 to December 31, 2020), as compared to the same period in 2019. The number of exams, cancer detection rates, pathologic findings and risk factors were analyzed. Results A total of 32,144 patients were included in the study. Breast imaging exams and procedures decreased by 78.9% in the first period, and 2.7% in the second period, in 2020. By the end of 2020, the number of breast cancer lesions detected was just six cases less than in 2019, although the number of patients submitted to mammograms was 35% lower. Conclusion There was a drop in number of breast exams and cancer diagnoses in the first 90 days of the pandemic. The decrease in diagnosis of cancer was partially compensated in the second period, but the number of patients submitted to mammograms by the end of 2020 was lower, still considering a large number of patients with delayed exams.

RESUMO Objetivo Avaliar o impacto da pandemia da COVID-19 no diagnóstico de câncer de mama em um centro de imagem de mama. Métodos Estudo de coorte retrospectivo que incluiu mulheres submetidas a exames e procedimentos de mama em um hospital privado em São Paulo, SP, Brasil, no período de medidas mais rigorosas de isolamento social em 2020 (dividido em primeiro período, de 24 de março a 21 de junho de 2020, e em segundo período, de 22 de junho a 31 de dezembro de 2020), comparado com o mesmo período de 2019. Foram analisados o número de exames, as taxas de detecção de câncer, os achados patológicos e os fatores de risco. Resultados Foram incluídas 32.144 pacientes. Os exames e os procedimentos de imagem da mama em 2020 tiveram redução de 78,9% no primeiro período e 2,7% no segundo período. Ao final de 2020, foram diagnosticadas com câncer de mama seis pacientes a menos do que em 2019, embora o número de pacientes submetidas à mamografia tenha sido 35% menor. Conclusão Houve queda no número de exames de mama e de diagnósticos de câncer nos primeiros 90 dias da pandemia. A redução dos diagnósticos de câncer foi parcialmente compensada no segundo período, mas o número de pacientes submetidas a exames de mamografia até o final do ano foi menor, considerando ainda um grande número de pacientes com exames atrasados.

Regulación autonómica cardiovascular durante la prueba del peso sostenido en pacientes sanos y diabéticos tipo 2 / Autonomic cardiovascular regulation during the sustained weight test in healthy subjects and type 2 diabetic patients

Introducción: En la actualidad se hace imprescindible el estudio de la diabetes mellitus tipo 2 a partir de técnicas poco costosas en función de la carga sanitaria que representa, es entonces donde la prueba del peso sostenido gana valor como ejercicio isométrico estático cubano en el estudio de la variabilidad de la frecuencia cardíaca. Objetivo: Determinar las respuestas electrofisiológicas autonómicas y hemodinámicas en estado basal y durante la prueba del peso sostenido en pacientes sanos y con diabetes tipo 2. Métodos: Se realizó un estudio en la Universidad de Ciencias Médicas de Santiago de Cuba, no observacional, cuasi-experimental, de tipo antes-después con grupo control de 60 pacientes (30 sanos y 60 con diabetes mellitus tipo 2). Resultados: Los diabéticos presentaron mayor IMC (p = 0,004). En estado basal se experimentaron diferencias significativas entre pacientes sanos y diabéticos. En la mayoría, los parámetros de la variabilidad de la frecuencia cardíaca analizados y durante la prueba del peso sostenido, solo se observaron diferencias significativas en las variables TAS (p = 0,022), BF (p = 0,001) y AF (p = 0,015). Al realizar la prueba del peso sostenido se encontraron variaciones muy significativas (p < 0,001) de los parámetros hemodinámicos, y variaciones significativas de AF (p = 0,023) y BF/AF (p = 0,046) en pacientes sanos; y en diabéticos, diferencias significativas de las variables hemodinámicas. Conclusiones: Se determinó una menor respuesta en pacientes diabéticos con respecto a los sanos del sistema nervioso autónomo, lo que expresa un deterioro de este y una disminución de la actividad simpática y parasimpática(AU)

Introduction: At present it is indispensable to study type 2 diabetes mellitus with low-cost techniques due to the health load it represents. In this context the sustained weight test acquires great value as a Cuban static isometric exercise for the study of heart rate variability. Objective: Determine autonomic and hemodynamic electrophysiological responses at baseline state and during the sustained weight test in healthy subjects and type 2 diabetic patients. Methods: A non-observational quasi-experimental before-after study was conducted at the University of Medical Sciences of Santiago de Cuba based on a control group of 60 patients (30 healthy and 30 with type 2 diabetes mellitus). Results: Diabetics had a higher BMI (p = 0.004). At baseline state significant differences were found between healthy subjects and diabetic patients. In most of the heart rate variability parameters analyzed and during the sustained weight tests, the only variables that showed significant differences were SBP (p = 0.022), FB (p = 0.001) and FA (p = 0.015). The results obtained from the sustained weight test were the following: very significant variations of hemodynamic parameters (p < 0.001), significant FA (p = 0.023) and FB/FA (p = 0.046) variations in healthy subjects, and significant differences in hemodynamic variables in diabetic patients. Conclusions: A lower response by the autonomic nervous system was determined in diabetic patients versus healthy subjects, signaling deterioration of that system and reduced sympathetic and parasympathetic activity(AU)

Nanoneedle-like zinc oxide as a filler particle for an experimental adhesive resin

Aim: The aim of this study was to develop an experimental adhesive resin with nanoneedle-like zinc oxide (N-ZnO), an inorganic filler, that could avoid particle agglomeration and lead to a homogeneous stress distribution within the material and characterize it. Materials and Methods: N-ZnO particles obtained by a thermal evaporation technique were characterized regarding size and surface area and added at 0 (control), 1, 2, 5, and 10 wt%, to an experimental adhesive resin. The following experimental adhesive resins' properties were assessed: radiopacity, contact angle to conditioned enamel and dentin, color, degree of conversion, flexural strength, resistance to degradation, and cytotoxicity. Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test and paired Student's t-test. Results: Particles presented a mean particle size of 40 nm and a specific surface area of 16 m2/g. N-ZnO10%showed an increased radiopacity when compared to N-ZnO0%. Contact angles were significantly higher for N-ZnO10%at enamel and N-ZnO2%, N-ZnO5%, and N-ZnO10%at dentin. All groups showed color change when compared to N-ZnO0%. Higher the N-ZnO concentration, lower the degree of conversion. There were no significant differences between the groups for flexural strength and resistance to degradation. The addition of N-ZnO showed no difference in cytotoxicity when compared to positive control, N-ZnO0%, and all groups showed higher values than negative control. Conclusions: N-ZnO possibly exceeded potential limitations due to particles' agglomeration and improved the transference and distribution of stress within the material. It could be effectively used as a filler for adhesive resins.

Manejo Quirúrgico del cáncer de mama en la Unidad Oncológica de la Sociedad Oncológica de Lucha Contra el Cáncer, Chimborazo, Ecuador 2015-2017 / Surgical Management of breast cancer in the Oncology Unit of the Oncology Society for the Fight Against Cancer, Chimborazo, Ecuador 2015-2017

INTRODUCCIÓN. El cáncer de mama resulta una de las neoplasias malignas más frecuente en las mujeres y se asocia con una alta morbilidad y mortalidad a nivel mundial. OBJETIVO. Caracterizar el manejo quirúrgico del cáncer de mama. MATERIALES Y MÉTODOS. Se desarrolló un estudio con enfoque mixto, descriptivo transversal, con una muestra de 80 pacientes. Criterios de inclusión; intervenidas quirúrgicamente mediante mastectomía lateral debido a un diagnóstico de cáncer de mamas. En la Unidad Oncológica de la Sociedad Oncológica de Lucha Contra el Cáncer, Chimborazo, durante el período 2015-2017. Se realizó la revisión de Historias Clínicas Únicas que permitió recopilar los datos mediante la respectiva ficha. Se analizó los datos en el programa Microsoft Excel. RESULTADOS. El 63,75 % (51;80) fue de etnia mestiza y aquellas con edades superiores a 50 años 56,23% (45;80). No existió diferencias importantes entre las prácticas conservadoras con respecto a radicales. La mayoría de los diagnósticos se realizaron en el estadío III, de lateralidad izquierda 63,75% (51;80) y con receptores hormonales luminal A. CONCLUSIÓN. El tratamiento adyuvante resultó el que más se aplicó a las afectadas, no reportándose casos de recurrencia o de progresión de la enfermedad.

INTRODUCTION. Breast cancer is one of the most common malignancies in women and is associated with high morbidity and mortality worldwide. OBJECTIVE. Characterize the surgical management of breast cancer. MATERIALS AND METHODS. A study with a mixed, descriptive, cross-sectional approach was developed with a sample of 80 patients. Inclusion criteria; underwent surgery by lateral mastectomy due to a diagnosis of breast cancer. In the Oncology Unit of the Oncology Society for the Fight Against Cancer, Chimborazo, during the period 2015-2017. The review of Unique Clinical Histories was carried out, which allowed data to be collected through the respective file. The data was analyzed in the Microsoft Excel program. RESULTS 63,75% (51; 80) were of mixed race ethnicity and those with ages over 50 years old 56,23% (45; 80). There were no significant differences between conservative practices with respect to radicals. The majority of diagnoses were made in stage III, with 63,75% left laterality (51; 80) and with luminal hormone receptors A. CONCLUSION. The adjuvant treatment was the one that was most applied to those affected, with no reports of recurrence or disease progression.

Proposta de escore preditor de desfechos para abdome agudo / Outcomes prediction score for acute abdomen: a proposal

RESUMO Objetivo: estabelecer a correlação entre dados objetivos coletados na avaliação inicial e os desfechos nos casos de dor abdominal aguda. Métodos: estudo retrospectivo, de caso controle, em que foram revisados prontuários de pacientes atendidos em um serviço de urgência e emergência no ano de 2016, diagnosticados com dor abdominal e pélvica. Resultados: de 2.352 prontuários avaliados, 330 foram considerados válidos para o estudo. Destes pacientes, 235 (71,2%) receberam alta e os 95 (28,8%) restantes foram internados, submetidos à cirurgia ou morreram. A análise estatística demonstrou que sexo masculino, idade ≥50 anos, temperatura axilar >37,3ºC, anemia, leucocitose >10.000/mm3, neutrocitose acima de 7.700/mm3, linfopenia <2.000/mm3 e hiperamilasemia são variáveis isoladamente associadas a pior desfecho. Conclusão: a presença de três ou mais das variáveis avaliadas aumenta fortemente a chance de um paciente sofrer os desfechos de cirurgia ou morte, sendo a chance de óbito tanto maior quanto maior o número de variáveis presentes.

ABSTRACT Objective: to establish a correlation between objective data collected at the initial evaluation and the outcomes in cases of acute abdominal pain. Methods: we conducted a retrospective, case-control study in which we reviewed medical records of patients treated at an emergency room in 2016, diagnosed with abdominal and pelvic pain. Results: of the 2,352 medical records evaluated, we considered 330 valid for the study. Of these patients, 235 (71.2%) were discharged and the remaining 95 (28.8%) were hospitalized, submitted to surgery, or died. The statistical analysis demonstrated that male gender, age ≥50, axillary temperature >37.3ºC, anemia, leukocytosis >10,000/mm3, neutrophil count above 7,700/mm3, lymphocyte count less than 2,000/mm3 and hyperamylasemia were variables in independently associated with worse outcome. Conclusion: the presence of three or more of the evaluated variables greatly increases the chances of a patient suffering the outcomes of surgery or death, the chance of death being greater the greater the number of variables present.

Current applications and different approaches for microbial L-asparaginase production

ABSTRACT L-asparaginase (EC 3.5.1.1) is an enzyme that catalysis mainly the asparagine hydrolysis in L-aspartic acid and ammonium. This enzyme is presented in different organisms, such as microorganisms, vegetal, and some animals, including certain rodent's serum, but not unveiled in humans. It can be used as important chemotherapeutic agent for the treatment of a variety of lymphoproliferative disorders and lymphomas (particularly acute lymphoblastic leukemia (ALL) and Hodgkin's lymphoma), and has been a pivotal agent in chemotherapy protocols from around 30 years. Also, other important application is in food industry, by using the properties of this enzyme to reduce acrylamide levels in commercial fried foods, maintaining their characteristics (color, flavor, texture, security, etc.) Actually, L-asparaginase catalyzes the hydrolysis of L-asparagine, not allowing the reaction of reducing sugars with this aminoacid for the generation of acrylamide. Currently, production of L-asparaginase is mainly based in biotechnological production by using some bacteria. However, industrial production also needs research work aiming to obtain better production yields, as well as novel process by applying different microorganisms to increase the range of applications of the produced enzyme. Within this context, this mini-review presents L-asparaginase applications, production by different microorganisms and some limitations, current investigations, as well as some challenges to be achieved for profitable industrial production.

Tranexamic acid action on liver regeneration after partial hepatectomy: experimental model in rats / Ação do ácido tranexâmico na regeneração hepática após hepatectomia parcial: modelo experimental em ratos

ABSTRACT Background: Different lesions may affect the liver resulting in harmful stimuli. Some therapeutic procedures to treat those injuries depend on liver regeneration to increase functional capacity of this organ. Aim: Evaluate the effects of tranexamic acid on liver regeneration after partial hepatectomy in rats. Method: 40 rats (Rattus norvegicus albinus, Rodentia mammalia) of Wistar-UP lineage were randomly divided into two groups named control (CT) and tranexamic acid (ATX), with 20 rats in each. Both groups were subdivided, according to liver regeneration time of 32 h or seven days after the rats had been operated. The organ regeneration was evaluated through weight and histology, stained with HE and PCNA. Results: The average animal weight of ATX and CT 7 days groups before surgery were 411.2 g and 432.7 g, and 371.3 g and 392.9 g after the regeneration time, respectively. The average number of mitotic cells stained with HE for the ATX and CT 7 days groups were 33.7 and 32.6 mitosis, and 14.5 and 14.9 for the ATX and CT 32 h groups, respectively. When stained with proliferating cell nuclear antigen, the numbers of mitotic cells counted were 849.7 for the ATX 7 days, 301.8 for the CT 7 days groups, 814.2 for the ATX 32 hand 848.1 for the CT 32 h groups. Conclusion: Tranexamic acid was effective in liver regeneration, but in longer period after partial hepatectomy.

RESUMO Racional: Muitas são as injúrias que acometem o fígado e levam a estímulo lesivo. Alguns procedimentos terapêuticos para tratamento dessas lesões dependem da regeneração hepática para aumentar a sua capacidade funcional. Objetivo: Avaliar o efeito do ácido tranexâmico na regeneração hepática após hepatectomia parcial em ratos. Método: Foram utilizados 40 ratos (Rattus norvegicus albinus, Rodentia mammalia) convencionais da linhagem Wistar-UP. Foram divididos aleatoriamente em dois grupos de 20: grupo controle (CT) e grupo ácido tranexâmico (ATX). Cada um deles foi divido em dois subgrupos para avaliar a regeneração hepática no tempo de 32 h e 7 dias do pós-operatório. A regeneração do órgão foi avaliada quanto ao peso e histologia, sendo esta última por hematoxilina-eosina e antígeno nuclear de proliferação celular. Resultados: A média dos pesos dos animais dos grupos ATX 7 dias e CT 7 dias no pré-operatório foram de 411,2 g e 432,7 g, respectivamente, e após a regeneração foram de 371,3 g e 392,9 g. As médias das taxas de mitose coradas por HE dos dois grupos em 7 dias foram de 33,7 e 32,6 mitoses, respectivamente, e de 14,5 e 14,9 mitoses para os grupos ATX e CT 32 h. A contagem de células por antígeno nuclear de proliferação celular mostrou valores de 849,7 para o grupo ATX 7 dias e 301,8 para o CT 7 dias; 814,2 para o grupo ATX 32 h e 848,1 para o CT 32 h. Conclusão: O ácido tranexâmico mostrou-se efetivo na regeneração hepática somente em período mais longo de observação após hepatectomia parcial.

Current applications and different approaches for microbial L-asparaginase production

ABSTRACT L-asparaginase (EC 3.5.1.1) is an enzyme that catalysis mainly the asparagine hydrolysis in L-aspartic acid and ammonium. This enzyme is presented in different organisms, such as microorganisms, vegetal, and some animals, including certain rodent's serum, but not unveiled in humans. It can be used as important chemotherapeutic agent for the treatment of a variety of lymphoproliferative disorders and lymphomas (particularly acute lymphoblastic leukemia (ALL) and Hodgkin's lymphoma), and has been a pivotal agent in chemotherapy protocols from around 30 years. Also, other important application is in food industry, by using the properties of this enzyme to reduce acrylamide levels in commercial fried foods, maintaining their characteristics (color, flavor, texture, security, etc.) Actually, L-asparaginase catalyzes the hydrolysis of L-asparagine, not allowing the reaction of reducing sugars with this aminoacid for the generation of acrylamide. Currently, production of L-asparaginase is mainly based in biotechnological production by using some bacteria. However, industrial production also needs research work aiming to obtain better production yields, as well as novel process by applying different microorganisms to increase the range of applications of the produced enzyme. Within this context, this mini-review presents L-asparaginase applications, production by different microorganisms and some limitations, current investigations, as well as some challenges to be achieved for profitable industrial production.

Observaciones sobre la Morfología del Oviducto del Coipo (Myocastor coypus) / Observations on Oviduct Morphology of the Coypu (Myocastor coypus)

Se efectuaron los análisis anatómico e histoarquitectónico del oviducto del coipo (Myocastor coypus) en la madurez sexual. Se trabajó con 34 oviductos que fueron segmentados en infundíbulo, ampolla, unión ámpulo-ístmica, istmo cefálico, medio y caudal y procesados con técnicas histológicas de rutina. Los oviductos se observaron como órganos tubulares y tortuosos, con amplia superficie infundibular, marcada flexura en la unión con los cuernos uterinos y el desarrollo de un colículo en la unión útero-tubárica. La mucosa presentó plegamientos que disminuyeron en número, grado de ramificación y altura desde la ampolla hasta los comienzos de la unión útero-tubárica. El epitelio de revestimiento estuvo compuesto por células ciliadas y células secretoras. En el infundíbulo y el istmo fue cilíndrico simple, en tanto que en la ampolla fue seudoestratificado cilíndrico. En las regiones caudales del istmo se observaron criptas revestidas por un epitelio cilíndrico de aspecto secretor. La lámina propia fue de tejido conectivo laxo y muy vascularizado. La túnica muscular incrementó su grosor y complejidad desde el infundíbulo a la unión útero-tubárica.

Anatomical and histoachitectonic analyses of coypu (Myocastor coypus) oviduct were performed at sexual maturity. Thirty-four oviducts were segmented into: infundibulum, ampulla, cephalic istmus, middle and caudal. Routine histological techniques were used. Oviducts were observed as tubular and tortuous organs with a wide infundibular surface, a pronounce flexure at junction of the uterine horns and with a colliculus at the utero-tubaric junction. The oviductal wall was composed of the mucosal, muscular and serosal tunics. The mucosal tunic showed foldings that diminished in number, ramification and height from the ampulla to the beginning of the utero-tubaric junction. The lining epithelium was composed of ciliated cells as well as secretory cells. In the infundibulum and isthmus, it was simple and cylindrical, while in the ampoule it was cylindrical pseudo-stratified. In the caudal regions of the isthmus, crypts covered by a cylindrical epithelium with secretroy aspect were observed. The lamina propria was composed of highly vascularized lax connective tissue. The muscular tunic increased its thickness and complexity from the infundibulum to the utero-tubaric junction.

Influência da cirurgia ortognática na harmonia facial: série de casos / Influence of orthognathic surgery on facial harmony: case series

A cirurgia ortognática é uma opção terapêutica viável no tratamento daqueles pacientes que apresentam deformidades dento-esqueléticas. De acordo com a literatura, esse procedimento cirúrgico possibilita aos pacientes resultados funcionais e estéticos, proporcionando mudanças significativas na vida destes. Sendo assim, este trabalho teve por objetivo relatar uma série de casos de pacientes submetidos à cirurgia ortognática, cujos resultados pós-operatórios demonstram uma importante melhora na harmonia facial destes, o que vem a confirmar que esse procedimento é um importante instrumento de mudança na vida dos pacientes, possibilitando uma convivência normal destes em sociedade... (AU)

The orthognathic surgery is a viable therapeutic option in the treatment of those patients who have dental-skeletal deformities. According to the literature, this surgical procedure allows the functional and aesthetic results patients, providing significant changes in their lives. Thus, this study aimed to report a case series of patients undergoing orthognathic surgery whose postoperative results show a significant improvement in facial harmony of the same, which confirms that this procedure is an important tool change in the lives of patients, allowing a normal coexistence of these patients in society... (AU)